While the repeal efforts aimed at the Affordable Care Act (A.C.A.), or ObamaCare, are over for now, efforts to destabilize the landmark health care law are ongoing. We need to stay focused on the attacks on health care that threaten access to care.

In many areas, health plans have used uncertainty over A.C.A. to pull services from exchanges or drastically increase rates. The health care markets are under fire right now from several different attacks on the Affordable Care Act leveled by the executive branch. Indeed, the President and the Executive branch have made it clear that they would like ObamaCare to implode, to complete the destruction of the A.C.A. Continuing efforts to undermine the A.C.A. though the administrative process are destabilizing the A.C.A. more than what we can see.

Latest Attack: Cutting Subsidies

On October 12, the Trump administration announced they would default on their obligations to pay cost-sharing reductions, or C.S.R.’s, that are crucial to a stable, affordable health care market on the health care exchanges where consumers purchase health care on what is known as the individual market. This means Americans who purchase health insurance through an A.C.A. health care exchange as part of the Medicaid expansion, costs for health insurance are about to sky rocket.

The CSRs allow those who meet income limits and cannot afford to purchase insurance to receive a subsidy toward their health insurance premiums. Since 2014, the federal government has made these payments that allow recipients to dramatically lower the cost of health care, from premiums to deductibles and co-pays.

Without these C.S.R. payments, many people who acquired coverage through Medicaid expansion, which gave coverage to an estimated 20 million Americans, will not be able to afford individual insurance.

Latest Attack: Regulations

Also on October 12, President Trump signed an executive order that “broadly tasks the administration with developing policies to increase health care competition and choice in order to improve the quality of health care and lower prices,” according to CNN.com.

The executive order:

• Directs the US Department of Labor to study how to make it easier for small businesses to buy health insurance through nationwide plans;
• Allows consumers to buy short-term policies, without ObamaCare protections, sometimes called junk insurance; and,
• Broadens employer ability to use Health Reimbursement Arrangements to buy their own coverage.

The essential benefits required by the A.C.A. were designed in part to address concerns with so-called “junk insurance” where the insurance coverage was limited to specific parts of health care, leaving huge gaps in coverage for things such as hospitalization, prescription drugs and maternity care. Consumers who purchase these plans may still be at risk for catastrophic health care debt, and will be less likely to schedule preventative care if it they have to pay significant out-of-pocket fees. Under the A.C.A., certain preventative care is free of cost to patients.

Attack: Cut Advertising 90%

In August, we learned the Trump administration announced the funding for advertising for ObamaCare was going to be cut by 90%, the New York Times reported. Last year, the budget was $100 million.

The Senate Democratic leader, Chuck Schumer of New York, denounced the cutbacks. “The Trump administration is deliberately attempting to sabotage our health care system,” he said. “When the number of people with health insurance declines and costs skyrocket, the American people will know who’s to blame.”

Attack: Cut Enrollment Period 50%

The open enrollment period for A.C.A. policies has been cut down to 45 days, half of the time from last year. While California runs its own exchange which will have regular open enrollment, for the 35 states where residents buy health care through the A.C.A. exchange at healthcare.gov, the standard three-month time period for enrolling for a health care plan has been cut in half. An NPR article explains:

However, the agency this year has made major changes, including cutting the open enrollment period for the 35 states that use the federal website, Healthcare.gov, to six weeks from three months. Open enrollment for those customers starts on November 1 and ends December 15.

To add insult to injury, the Administration has also announced that healthcare.gov will be undergoing maintenance for twelve hours on five of six Sundays during open enrollment. PBS.org reported that the for every Sunday but December 10, the website would be shut down from 12 am-12 pm.

Linda Blumberg, a senior fellow at the Urban Institute, said this decision for reduced hours on top of that hurts people with inflexible work schedules and limited access to Internet and services.

“That’s the height of irresponsibility,” Blumberg said. “It’s just one more thing to create difficulty for people to be able to access the insurers they need through the law as it was written.”

Conclusion

Significantly reducing the time that people can sign up for insurance and drastically cutting the advertising budget for ObamaCare will without a doubt reduce the number of people who sign up for health care on the exchanges, increasing the rate of uninsured Americans.

Each of these attacks is intended to undermine the Affordable Care Act. Users outside of the national exchange will not necessarily face all of these impediments, but all who buy health insurance through the A.C.A. will be impacted. Cumulatively, they will destabilize the Affordable Care Act health care exchanges and put everyone who has gained access through the Medicaid expansion at risk of losing care. At the end of the day, we are not out of the woods yet when it comes to access to health care.